Combining baseline characteristics to disentangle response differences to disorder-specific versus supportive psychotherapy in patients with persistent depressive disorder

Ilinca Serbanescu; Henrik Walter; Knut Schnell; Henrik Kessler; Bernd Weber; Sarah Drost; Magdalena Groß; Peter Neudeck; Jan Philipp Klein; Nele Assmann; Ingo Zobel; Matthias Backenstrass; Martin Hautzinger; Ramona Meister; Martin Härter; Elisabeth Schramm; Dieter Schoepf

doi:10.1016/j.brat.2019.103512

Combining baseline characteristics to disentangle response differences to disorder-specific versus supportive psychotherapy in patients with persistent depressive disorder

Ilinca Serbanescu^*, Henrik Walter, Knut Schnell, Henrik Kessler, Bernd Weber, Sarah Drost, Magdalena Groß, Peter Neudeck, Jan Philipp Klein, Nele Assmann, Ingo Zobel, Matthias Backenstrass, Martin Hautzinger, Ramona Meister, Martin Härter, Elisabeth Schramm, Dieter Schoepf

^*Corresponding author for this work

Clinic of Psychiatry and Psychotherapy

16 Citations (Scopus)

Abstract

Does the pre-treatment profile of individuals with persistent depressive disorder (PDD) moderate their benefit from disorder-specific Cognitive Behavioral System of Psychotherapy (CBASP) versus supportive psychotherapy (SP)? We investigated this question by analyzing data from a multi-center randomized clinical trial comparing the effectiveness of 48 weeks of CBASP to SP in n = 237 patients with early-onset PDD who were not taking antidepressant medication. We statistically developed an optimal composite moderator as a weighted combination of 13 preselected baseline variables and used it for identifying and characterizing subgroups for which CABSP may be preferable to SP or vice versa. We identified two distinct subgroups: 58.65% of the patients had a better treatment outcome with CBASP, while the remaining 41.35% had a better outcome with SP. At baseline, patients responding more favorably to CBASP were more severely depressed and more likely affected by moderate-to-severe childhood trauma including early emotional, physical, or sexual abuse, as well as emotional or physical neglect. In contrast, patients responding more favorably to SP had a higher pre-treatment global and social functioning level, a higher life quality and more often a recurrent illness pattern without complete remission between the episodes. These findings emphasize the relevance of considering pre-treatment characteristics when selecting between disorder-specific CBASP and SP for treating PDD. The practical implementation of this approach would advance personalized medicine for PDD by supporting mental health practitioners in their selection of the most effective psychotherapy for an individual patient.

Original language	English
Article number	103512
Journal	Behaviour Research and Therapy
Volume	124
ISSN	0005-7967
DOIs	https://doi.org/10.1016/j.brat.2019.103512
Publication status	Published - 01.2020

Funding

This trial was funded by grants of the German Research Foundation ( SCHR443/11-1 , SCHR 443/11-2 , and WA1539/4-1 ). The sponsor ( German Research Foundation ) has reviewed and approved the study protocol in the context of the grant application process. It had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. We want to express our thanks to Professor Helena Chmura Kraemer, Stanford University, USA, for her invaluable help regarding the statistical analyses. We are grateful to all participating patients and their families, as well as to all therapists and outcome evaluators. This study would not have been possible without their efforts and dedication. Appendix A

Research Areas and Centers

Academic Focus: Center for Brain, Behavior and Metabolism (CBBM)

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.brat.2019.103512

Cite this

Serbanescu, I., Walter, H., Schnell, K., Kessler, H., Weber, B., Drost, S., Groß, M., Neudeck, P., Klein, J. P., Assmann, N., Zobel, I., Backenstrass, M., Hautzinger, M., Meister, R., Härter, M., Schramm, E., & Schoepf, D. (2020). Combining baseline characteristics to disentangle response differences to disorder-specific versus supportive psychotherapy in patients with persistent depressive disorder. Behaviour Research and Therapy, 124, Article 103512. https://doi.org/10.1016/j.brat.2019.103512

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title = "Combining baseline characteristics to disentangle response differences to disorder-specific versus supportive psychotherapy in patients with persistent depressive disorder",

abstract = "Does the pre-treatment profile of individuals with persistent depressive disorder (PDD) moderate their benefit from disorder-specific Cognitive Behavioral System of Psychotherapy (CBASP) versus supportive psychotherapy (SP)? We investigated this question by analyzing data from a multi-center randomized clinical trial comparing the effectiveness of 48 weeks of CBASP to SP in n = 237 patients with early-onset PDD who were not taking antidepressant medication. We statistically developed an optimal composite moderator as a weighted combination of 13 preselected baseline variables and used it for identifying and characterizing subgroups for which CABSP may be preferable to SP or vice versa. We identified two distinct subgroups: 58.65\% of the patients had a better treatment outcome with CBASP, while the remaining 41.35\% had a better outcome with SP. At baseline, patients responding more favorably to CBASP were more severely depressed and more likely affected by moderate-to-severe childhood trauma including early emotional, physical, or sexual abuse, as well as emotional or physical neglect. In contrast, patients responding more favorably to SP had a higher pre-treatment global and social functioning level, a higher life quality and more often a recurrent illness pattern without complete remission between the episodes. These findings emphasize the relevance of considering pre-treatment characteristics when selecting between disorder-specific CBASP and SP for treating PDD. The practical implementation of this approach would advance personalized medicine for PDD by supporting mental health practitioners in their selection of the most effective psychotherapy for an individual patient.",

author = "Ilinca Serbanescu and Henrik Walter and Knut Schnell and Henrik Kessler and Bernd Weber and Sarah Drost and Magdalena Gro{\ss} and Peter Neudeck and Klein, \{Jan Philipp\} and Nele Assmann and Ingo Zobel and Matthias Backenstrass and Martin Hautzinger and Ramona Meister and Martin H{\"a}rter and Elisabeth Schramm and Dieter Schoepf",

note = "Funding Information: This trial was funded by grants of the German Research Foundation ( SCHR443/11-1 , SCHR 443/11-2 , and WA1539/4-1 ). The sponsor ( German Research Foundation ) has reviewed and approved the study protocol in the context of the grant application process. It had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. We want to express our thanks to Professor Helena Chmura Kraemer, Stanford University, USA, for her invaluable help regarding the statistical analyses. We are grateful to all participating patients and their families, as well as to all therapists and outcome evaluators. This study would not have been possible without their efforts and dedication. Appendix A Publisher Copyright: {\textcopyright} 2019 Elsevier Ltd Copyright: Copyright 2020 Elsevier B.V., All rights reserved.",

year = "2020",

month = jan,

doi = "10.1016/j.brat.2019.103512",

language = "English",

volume = "124",

journal = "Behaviour Research and Therapy",

issn = "0005-7967",

publisher = "Elsevier Ltd",

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Serbanescu, I, Walter, H, Schnell, K, Kessler, H, Weber, B, Drost, S, Groß, M, Neudeck, P, Klein, JP , Assmann, N, Zobel, I, Backenstrass, M, Hautzinger, M, Meister, R, Härter, M, Schramm, E & Schoepf, D 2020, 'Combining baseline characteristics to disentangle response differences to disorder-specific versus supportive psychotherapy in patients with persistent depressive disorder', Behaviour Research and Therapy, vol. 124, 103512. https://doi.org/10.1016/j.brat.2019.103512

Combining baseline characteristics to disentangle response differences to disorder-specific versus supportive psychotherapy in patients with persistent depressive disorder. / Serbanescu, Ilinca; Walter, Henrik; Schnell, Knut et al.
In: Behaviour Research and Therapy, Vol. 124, 103512, 01.2020.

Research output: Journal Articles › Journal articles › Research › peer-review

TY - JOUR

T1 - Combining baseline characteristics to disentangle response differences to disorder-specific versus supportive psychotherapy in patients with persistent depressive disorder

AU - Serbanescu, Ilinca

AU - Walter, Henrik

AU - Schnell, Knut

AU - Kessler, Henrik

AU - Weber, Bernd

AU - Drost, Sarah

AU - Groß, Magdalena

AU - Neudeck, Peter

AU - Klein, Jan Philipp

AU - Assmann, Nele

AU - Zobel, Ingo

AU - Backenstrass, Matthias

AU - Hautzinger, Martin

AU - Meister, Ramona

AU - Härter, Martin

AU - Schramm, Elisabeth

AU - Schoepf, Dieter

N1 - Funding Information: This trial was funded by grants of the German Research Foundation ( SCHR443/11-1 , SCHR 443/11-2 , and WA1539/4-1 ). The sponsor ( German Research Foundation ) has reviewed and approved the study protocol in the context of the grant application process. It had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. We want to express our thanks to Professor Helena Chmura Kraemer, Stanford University, USA, for her invaluable help regarding the statistical analyses. We are grateful to all participating patients and their families, as well as to all therapists and outcome evaluators. This study would not have been possible without their efforts and dedication. Appendix A Publisher Copyright: © 2019 Elsevier Ltd Copyright: Copyright 2020 Elsevier B.V., All rights reserved.

PY - 2020/1

Y1 - 2020/1

N2 - Does the pre-treatment profile of individuals with persistent depressive disorder (PDD) moderate their benefit from disorder-specific Cognitive Behavioral System of Psychotherapy (CBASP) versus supportive psychotherapy (SP)? We investigated this question by analyzing data from a multi-center randomized clinical trial comparing the effectiveness of 48 weeks of CBASP to SP in n = 237 patients with early-onset PDD who were not taking antidepressant medication. We statistically developed an optimal composite moderator as a weighted combination of 13 preselected baseline variables and used it for identifying and characterizing subgroups for which CABSP may be preferable to SP or vice versa. We identified two distinct subgroups: 58.65% of the patients had a better treatment outcome with CBASP, while the remaining 41.35% had a better outcome with SP. At baseline, patients responding more favorably to CBASP were more severely depressed and more likely affected by moderate-to-severe childhood trauma including early emotional, physical, or sexual abuse, as well as emotional or physical neglect. In contrast, patients responding more favorably to SP had a higher pre-treatment global and social functioning level, a higher life quality and more often a recurrent illness pattern without complete remission between the episodes. These findings emphasize the relevance of considering pre-treatment characteristics when selecting between disorder-specific CBASP and SP for treating PDD. The practical implementation of this approach would advance personalized medicine for PDD by supporting mental health practitioners in their selection of the most effective psychotherapy for an individual patient.

AB - Does the pre-treatment profile of individuals with persistent depressive disorder (PDD) moderate their benefit from disorder-specific Cognitive Behavioral System of Psychotherapy (CBASP) versus supportive psychotherapy (SP)? We investigated this question by analyzing data from a multi-center randomized clinical trial comparing the effectiveness of 48 weeks of CBASP to SP in n = 237 patients with early-onset PDD who were not taking antidepressant medication. We statistically developed an optimal composite moderator as a weighted combination of 13 preselected baseline variables and used it for identifying and characterizing subgroups for which CABSP may be preferable to SP or vice versa. We identified two distinct subgroups: 58.65% of the patients had a better treatment outcome with CBASP, while the remaining 41.35% had a better outcome with SP. At baseline, patients responding more favorably to CBASP were more severely depressed and more likely affected by moderate-to-severe childhood trauma including early emotional, physical, or sexual abuse, as well as emotional or physical neglect. In contrast, patients responding more favorably to SP had a higher pre-treatment global and social functioning level, a higher life quality and more often a recurrent illness pattern without complete remission between the episodes. These findings emphasize the relevance of considering pre-treatment characteristics when selecting between disorder-specific CBASP and SP for treating PDD. The practical implementation of this approach would advance personalized medicine for PDD by supporting mental health practitioners in their selection of the most effective psychotherapy for an individual patient.

UR - https://www.scopus.com/pages/publications/85074763441

U2 - 10.1016/j.brat.2019.103512

DO - 10.1016/j.brat.2019.103512

M3 - Journal articles

C2 - 31734568

AN - SCOPUS:85074763441

SN - 0005-7967

VL - 124

JO - Behaviour Research and Therapy

JF - Behaviour Research and Therapy

M1 - 103512

ER -

Combining baseline characteristics to disentangle response differences to disorder-specific versus supportive psychotherapy in patients with persistent depressive disorder

Abstract

Funding

Research Areas and Centers

UN SDGs

Access to Document

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